31 research outputs found
Clinical survey of neurosensory side-effects of mandibular parasymphyseal bone harvesting
The aim of the present survey was to assess neurosensory disturbances and/or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal and skin sensitivity of the chin/lower lip, divided into four regions, were determined via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the mandibular teeth from the left second bicuspid to the right second bicuspid was tested by cold vitality preoperatively and 12 months postoperatively. Teeth were grouped according to sensitivity alterations and distance from the harvesting defects, as measured on CT scans, and statistically significant differences sought. At 12 months, 29% of preoperatively vital cuspids overlying the harvesting defects revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia; hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3% (5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp sensitivity changes were statistically indistinguishable regarding distances between root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity in any tooth cannot be predicted simply on the basis of the distance between its apex and the harvesting osteotomy line
Langherans' cell histiocytosis: A case report of an eosinophilic granuloma of the mandible treated with bone graft surgery and endosseous titanium implants
Eosinophilic granuloma is the localized and most benign form of Langherans' cell histiocytosis. The disease shows a particular predilection for the head and neck region and usually involves the skull bunes, where it manifests as well-defined lytic lesions on standard radiographs. The case of an extensive lesion involving the body of the mandible in a 52-year-old man is reported. Operative procedures consisted of enucleation of the lytic lesion and follow-up with clinical examinations and computerized tomographic studies of the mandible at 2, 12 and 18 months postoperatively. Reconstructive surgery without radiotherapy was performed with an autologous bone graft from the iliac crest and implant placement to provide support for a dental restoration.
Key words: bone grafting, dental implants, eosinophilic granuloma, langgerhans' cell histiocytosis
Implant Success in Sinus-Lifted Maxillae and Native Bone: A 3-year Clinical and Computerized Tomographic Follow-up
Abstarct
Purpose: The present study was a 3-year follow-up evaluation of implant clinical success and radiographic
bone remodeling in sinus floors elevated with different autogenous bone-grafting procedures
and in similar native bone regions. Materials and Methods: This retrospective chart review examined
consecutive edentulous patients with severe jaw atrophy treated between 2000 and 2002 via sinus
lift, when needed, and implant insertion. Implants in sinus lift areas were divided into 4 groups by
graft source (iliac crest, chin area) and technique (bone block, particulate). Implants positioned in
native areas beneath the sinus floor served as controls. The cumulative success rate (CSR) and success
rate (SR) were calculated, and linear measurements of bone remodeling around implants were
assessed on computerized tomographic scans. Results were statistically compared with the Wilcoxon
signed rank test. Results: Twenty-eight patients were treated in the posterior maxilla via insertion of 70
screw-type, root-form, rough implants in 39 sinus-lifted areas. All surgical procedures were uneventful.
Twenty-four implants were positioned in native areas beneath the sinus floor. The implant CSR was
95.8% in native areas (1 failure/24 implants), 85% in sinuses lifted with particulate chin bone (3 failures/
20 implants), and 100% in the other 3 groups (8 in particulate iliac crest, 20 in chin block, 22 in
iliac crest block). Computerized tomographic scans revealed that bone remodeling around apices
caused implants to bulge into the sinuses in both particulate bone graft groups. Crestal remodeling
around implant necks was similar for all groups. Conclusions: The use of particulate chin bone grafts
in sinus lift procedures does not seem to yield optimal outcomes. Milled iliac crest and chin bone
tends to remodel around the implant apices, leading to bulging within the sinuses. Grafting sinuses
with either chin or iliac crest bone blocks yields the highest implant success rates and stable sinus
floors.
Key words: autogenous bone graft, atrophic maxilla, dental implants, osseointegration, sinus lif
Implant survival in maxillary and mandibular osseous onlay grafts and native bone: a 3-year clinical and computerized tomographic follow-up
Abstract
Purpose: This article discusses a 3-year retrospective survey of implant clinical survival and computerized
tomographic analysis of bone remodeling in atrophic alveolar crests reconstructed via various
autogenous bone grafting procedures and in similar regions of native bone. Materials and Methods:
The retrospective chart review included consecutive edentulous patients with severe alveolar crest
atrophy treated between 2000 and 2002 with onlay autogenous bone grafts in the mandible and anterior
maxilla (as needed) and implant insertion. Implant recipients were followed for 3 years. Defective
areas were reconstructed by bone graft harvested from the chin or iliac crest. Implants in reconstructed
areas were divided into 2 groups according to graft source. Implants in corresponding native
areas served as controls. Cumulative survival rate (CSR), survival rate, and confidence interval (CI)
were calculated, and linear measurements of bone remodeling around implants were assessed on
computerized tomographic scans. Results were compared for statistically significant differences by
Wilcoxon signed-rank test with a significance level a = .05. Results: Forty patients were treated with
109 screw-type, root-form, rough-surfaced implants inserted in 48 onlay grafts; 88 implants were
placed in native bone. The implant 3-year CSRs were 98.9% (CI 96.7% to 100%) in native bone and
99.1% (CI 97.3% to 100%) in onlay grafts, irrespective of bone source. Mean resorption in the maxilla
was 4.6 ± 0.9 mm buccally and 3.8 ± 0.8 mm palatally in areas reconstructed with chin grafts, 3.4 ±
1.7 mm buccally and 2.6 ± 1.4 mm palatally in areas reconstructed with iliac crest grafts, and 3.2 ±
1.2 mm buccally and 2.1 ± 0.9 mm palatally in native areas. Conclusions: Similar implant CSRs were
seen in native and grafted sites. Maximal implant CSR was observed in onlay grafts from the chin
despite more marked linear bone remodeling in this group as compared to iliac crest grafts or native
bone.
Key words: atrophic mandible, atrophic maxilla, autogenous bone graft, dental implants, onlay bone
graft, osseointegratio
Volume changes of autogenous bone grafts after alveolar ridge augmentation of atrophic maxillae and mandibles
Abstract. The aim of the present retrospective chart review was to determine
the relationship between nonvascularized osseous graft remodeling and the threedimensional
(3D) features of grafts and recipient sites, the anatomical recipient
regions and different graft sources. 32 iliac crest or chin grafts were onlaypositioned
in the mandible or maxilla of 14 patients. CT scans, taken before implant
positioning and after 1 year, revealed a mean volume resorption of 35–51%. For
iliac crest grafts, the average resorption was 42% when the onlay was positioned in
the anterior maxilla and 59% when it was positioned in the posterior mandible.
Spearman correlation and 3D interpolation analysis revealed, for both iliac crest
groups, amoderate or advanced remodeling pattern depending on3Dfeatures, namely
graft thickness and shape, basal bone volume of recipient site, and the basal bone/graft
volume ratio of the recipient site. No statistically significant differences were found
between the recipient and donor site groups. Retrospective analysis of the data
indicates that iliac crest grafts, onlay-positioned on adequate basal bone volume,may
register a reduced volume remodeling when shaped thick in the anterior maxilla or
rounded and convex, on the external surface, in the posterior mandible.
Keywords: bone graft; bone resorption; interpolation
analysis; iliac crest graft; chin graft
Clinical survey of neurosensory side-effects of mandibular parasymphyseal bone harvesting
Abstract. The aim of the present survey was to assess neurosensory disturbances and/
or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting
procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal
and skin sensitivity of the chin/lower lip, divided into four regions, were determined
via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the
mandibular teeth from the left second bicuspid to the right second bicuspid was
tested by cold vitality preoperatively and 12 months postoperatively. Teeth were
grouped according to sensitivity alterations and distance from the harvesting
defects, as measured on CT scans, and statistically significant differences sought. At
12 months, 29% of preoperatively vital cuspids overlying the harvesting defects
revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia;
hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3%
(5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic
responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp
sensitivity changes were statistically indistinguishable regarding distances between
root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity
in any tooth cannot be predicted simply on the basis of the distance between its apex
and the harvesting osteotomy line.
Keywords: chin bone graft; mandibular parasymphyseal
bone harvesting; pulp sensitivity
loss; hypoaesthesia; hypoalgesia